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General NPI Number Information
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NPI Number | 1053918953
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Entity Type | Individual
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Provider Name | KOMALBEN SURESHKUMAR PATEL
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Gender | Female
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Dates
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Enumeration Date | 10/04/2020
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Last Update Date | 10/04/2020
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Provider Practice Location Address
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Address Line | 224 BEACH 20TH ST
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-3618
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Country | US
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Telephone | 347-926-4037
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Fax |
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Provider Business Mailing Address
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Address Line | 764 E THORNWOOD DR
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City | SOUTH ELGIN
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State | IL
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Zip | 60177-3241
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Country | US
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Telephone | 773-219-9679
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 044368
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License Number State | NY
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